Love Connection: The physiology of heartbreak

He told me it was over at lunch. We were sitting on the grass in the park, eating sandwiches. Thirty years later I don’t remember his words, but I’ll never forget the pain. Heart pounding, stomach clenched, nerves a jangle, vision blurry with tears, I made my way back through the crowded sidewalks. I rode up the elevator to my office on the 25th floor. “I’m sick,” I said, “I have to go home now.”

The emotions of that breakup stayed with me for a long time. I felt cast out of a life of possibilities and alone in a cold, dead world. Nothing could make me feel happy again. I couldn’t sleep or eat. I fell into a depression. Thirty years later (and happily married for 15 of them), when I think about that rejection, my heart still tightens, temples constrict, eyes mist.

Most of us have been through it, the broken state that is the very opposite of the dream of love. But heartbreak isn’t just a torment of the mind. It physically hurts and can even kill, say doctors. “People who go through a bad breakup experience real pain,” says Dr. Robin Tassinari, a professor of psychiatry and internal medicine at Albany Medical College.

The experience can be so intense and traumatic that it can affect brain plasticity, doctors say. Heartbreak can reinforce every bad thing we think about ourselves and our place in the world. And whenever we think about the breakup, we rehash those thoughts.

By definition, the heartbroken person is the one who didn’t want and wasn’t prepared for the breakup. The one who didn’t have a choice.

Sarah La Saulle, a marriage and family therapist, who co- wrote Healing a Broken Heart: A Guided Journal Through Four Seasons of Relationship Recovery, says that people who have had losses or trauma earlier in life will have a harder time recovering from heartbreak. “Their nervous system remembers,” she says. “It gets very activated, overwhelmed.”

Cultures the world over use words such as pain and hurt to express both physical pain and social rejection, notes a recent study that showed that the brain associates physical and emotional pain. The same parts of the brain (the secondary somatosensory cortex and the dorsal posterior insula) lit up when a hot probe was placed on subjects’ forearms as when they looked at a photo of and thought about a person who broke up with them and by whom they felt intensely rejected. The March 2011 report by Ethan Koss, a psychology professor at the University of Michigan, found “a neural overlap between physical pain and the emotional pain of intense social rejection.”

“The remarkable part is that sometimes the brain doesn’t know if it’s physical or emotional pain,” says Tassinari. “It’s the same neural pathway up the spine. The same circuits are involved.” In fact, Tylenol or acetaminophen can provide a temporary relief from heartache. “It fools the brain,” he says.

Doctors have discovered a new disease some call broken-heart syndrome.

Dying of a broken heart isn’t just an old wives’ tale. Doctors have discovered a new disease some call broken-heart syndrome. It seems just like a heart attack, with chest pain and shortness of breath that sends people to the hospital. The heart muscle is weakened and the sufferer (90 percent of whom are women) can become so ill they almost die. But the overwhelming majority fully recover, within a month or two.

Broken-heart syndrome, called “takotsubo” by many doctors, is named after the flared flasks used by the Japanese, who first identified the disease in 1990, to trap octopus. It differs from a heart attack in that the arteries are not blocked and a different part of the heart is damaged — the mid-portion and corner of the heart, which balloons into a shape of takotsubo.

“It’s fairly rare,” says Tassinari. Takotsubo disease represents just one to two percent of cases of what appear to be typical heart attacks. It wasn’t until around 1995 that doctors in the United States started to recognize and label it.

Takotsubo is similar to stress-induced cardiomyopathy, which is caused by major stress such as the death of a loved one, financial problems, a car accident or major illness. How does stress lead to heart-attack-like conditions? Doctors don’t know for sure, but studies point to adrenaline, what doctors call catecholamines. They cause blood vessels to restrict. People suffering from takotsubo disease have two to three times higher catecholamine levels than those having a real major heart attack.

Heartbreak doesn’t send most people to the hospital. Yet recovery can be a slow process. “Allow yourself to grieve and try not just to suck it up,” says Stram. We often take comfort in friends and family, but they can grow impatient. “After a while, people don’t want to hear it,” says La Saulle, “They say, ‘It’s been 3 months, oh, get over it.’”

Healing a Broken Heart is designed to “help comfort people, to ease the suffering” by helping them process the loss, she says. “The reason Sharon Kagan and I wrote it like a journal is that people get into an obsessive state and can get into a repetitive way of thinking. This is a way to process it without going into those patterns.”

Biofeedback can help us see the connection between our hearts and minds. And therapy can help us replace the unhealthy thoughts with healthy ones. But the largest challenge is that the brokenhearted continue to perceive things that cause stress as life-threatening. When that happens we need to stop and ask ourselves where those feelings are coming from. What is actually happening? Usually, the stressor is not life-threatening.

It’s not easy to change, but with help, we can learn over time. We have to. A broken heart is life-threatening. Says La Saulle, “You can get over it.”

Soothing a Broken Heart

Dr. Ronald Stram, founder of the Stram Center for Integrative Medicine in Albany, offers these suggestions for finding relief from the pain of heartbreak.

Meditation can help, but it can be tough if you’re too upset.

4-7-8 breathing can slow the heart rate and bring down blood pressure. Breathe in through the nose through four, hold to a count of 7, exhale slowly through eight counts. Do it 4 times. (It will take about five minutes.)

Avoid alcohol. It’s a sedative and a depressant and won’t help.

Drink calming teas, like chamomile or kava.

Avoid carbohydrates and eat more protein.

Get a massage. Craniosacral massage is remarkably gentle and helps with cerebrospinal flow.